POS0502 IMPLEMENTATION OF A CLINICAL CARE PATHWAY FOR SYSTEMATIC BONE FRAGILITY ASSESSMENT AT THE INITIATION OF ANDROGEN DEPRIVATION IN PROSTATE CANCER PATIENTS (HORMOS PROJECT)
Authors: O. Fogel, C. Dariane, J. E. Bibault, S. Kreps, C. Thibault, C. Gervais, A. Rochand, C. Meynard, E. Rapeaud, S. Hmila, F. Audenet, S. Oudard, A. Mejean, C. Roux, M. O. Timsit, K. Briot
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Androgen deprivation therapy (ADT) in prostate cancer (PCa) is associated with an increased risk of bone fragility including bone loss, osteoporosis and fractures. Although international recommendations suggest performing dual-energy x-ray absorptiometry (DXA) at the initiation of treatment, less than 10% of patients do it. The implementation of a standardised clinical care pathway could help prevent bone-related complications in patients starting ADT. <h3>Objectives</h3> To improve screening for bone fragility in patients starting ADT for PCa by setting up a clinical care pathway. To describe the characteristic of patients with PCa starting ADT. <h3>Methods</h3> The radiation oncologists, medical oncologists or urologists from a tertiary center systematically referred all patients starting any ADT for PCa to our rheumatology department for a bone-health assessment including a DXA and clinics with a bone specialist. The effectiveness of the pathway was assessed by the number of patients who performed DXA at the initiation of ADT. <h3>Results</h3> Between March and December 2022, 116 of the 119 patients (97%) referred to our department were able to have a bone assessment within an average of 36 +/- 15 days. The three patients not seen in the care pathway did not wish to come for a new medical appointment. Among the 116 patients, mean age at first visit was 75+/-7 years old, mean BMI 26.9 +/- 4.7 kg/m<sup>2</sup>, 56% were previous or current smoker and Charlson Comorbidity Index was 4.75 +/- 2.5 with 20% diabetes, 15% peripheral vascular disease, 11% coronaropathy and 10% chronic kidney disease. Regarding PCa, 65% were on a localized or locally-advanced stage while 35% were metastatic and overall, 44% presented with a high risk histo-pronostic score (ISUP 4 or 5). Sixty-four patients (55%) were scheduled to concomitant prostatic external beam radiation, as initial or salvage therapy. Median PSA at diagnosis was 16 ng/ml (8.8-38.5) At inclusion, 70% of patients were newly-diagnosed PCa while 30% were recurrent PCa. ADT was prescribed alone for 65% of patients or in combination with new hormone-therapy (NHT) for 35% of patients and 26% with concomitant corticosteroids with a mean dose of 10 +/-4 mg. The mean duration of previous ADT for relapsing patients was 16 +/- 20 months. Regarding bone disease, 11% patients had previous bone fracture mainly in the spine, 15% had familial history of hip fracture and 20% reported a fall within the past year. Forty-two percent of patients had vitamin D supplementation but only one was previously treated with an anti-osteoporotic agent. Finally, 114 patients had a DXA. A lumbar BMD T-score ≤-2.5 was found for 9 patients, ≤ -2 for 17 patients. A hip BMD T-score ≤ -2.5 was found for 12 patients and ≤ -2 for 35 patients. A T-score ≤ -2.5 to at least one site was found in 18 patients (16%) and ≤ -2 for 41 patients (35%). After BMD assessment, an anti-osteoporotic treatment was prescribed in 40% of patients with bisphosphonate (71%) or denosumab (29%). <h3>Conclusion</h3> This clinical care pathway allowed 97% of patients to have a bone assessment when starting ADT for PCa. This cohort of 116 patients confirms the high prevalence of low BMD among these patients and the need to screen and treat patients to prevent bone-related complications. <h3>Acknowledgements</h3> I thanks Mioranirainy DERAHARIJAONA and Catherine LE BOURLOUT for their help in collecting clinical data. <h3>Disclosure of Interests</h3> None Declared.